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S <br /> ' { u <br /> prtL 4 ;„ <br /> wW <br /> I will be installing the following: <br /> T s <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: 3 <br /> Size of Tanks: (COO 7000 <br /> Treatment System <br /> Trenches s.f. <br /> Mound s.f. <br /> Gravel less s.f. <br /> Chamber s.f. <br /> NOTE: The contractor is required to provide an As-Built of the system before the <br /> final inspection. <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system <br /> installation permit, agrees to do all the work in strict accordance with ordinances of the City <br /> and regulations of the State of Minnesota and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of Applicant ___t47Date: 1 _ z ( 0 <br /> MPCA License No.: (p Yo <br /> Staff Review: ccept ❑ Denied <br /> Reviewer: /L 001P' Date: <br /> 7-,2-F-10 <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): L-A--) 1 13e- <br /> 0 A ,tcioAeci or UAB:ice 0b-r:A, *fed ' Cfoioi <br /> 1--L <br /> W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc <br /> 2 / 2 <br />